Transcription of Consumer Complaint Form - Medical Board of California
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Medical Board of California Enforcement Program Instructions for Completing the 2005 Evergreen Street, Suite 1200. Sacramento, CA 95815-5401. Consumer Complaint Form Phone: (916) 263-2528. Fax: (916) 263-2435. 1. Legibly print or type all information. 2. Provide the full name and address of the licensee your Complaint is against. Please note that the Medical Board ( Board ) only handles complaints against the listed individuals on the second page. Please see the A Consumer 's Guide to the Complaint Process for additional information. 3. Attach a copy of any supporting documents you may have in your possession pertaining to your specific Complaint ; documents may include patient records, photographs, audio or video recordings, correspondence, billing statements, proof of payments, autopsy/toxicology report, police repo
Medical Board of California State of California Business, Consumer Services, and Housing Agency | Department of Consumer Affairs (Rev 06/20) 2005 Evergreen Street, Suite 1200 Medical Board of California Kaiser Authorization for …
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